The parts used in dental restorations travel from the machine shop to the dentist via the dental lab. But, as in many other areas of business and commerce, the middleman is being squeezed, as costs climb and technology offers alternatives to the traditional ways. And this is the scenario for the unfortunate dental technician. The artist whose job it is (or was) to craft prosthetic teeth is being usurped by machine shops equipped with the very latest in CNC.
Based near Amsterdam, Holland, Cyrtina BV has evolved from a milling centre using three-axis machines to produce simple parts, such as copings, into a provider of more complex crowns and bridges that can be supplied directly to the dentist, without the intercession of a dental technician.
Around four years ago, Cyrtina was producing just copings – frameworks for crowns or bridge abutments – which could be made easily on a three-axis machine. “However,” explains Siebe van der Zel, the company’s Chief Operating Officer, “to produce more complex dental parts efficiently, we knew we had to move up to five-axis machines. After investigating many different models and manufacturers, we found that Haas offered the best price-quality ratio.”
Cyrtina sought a sturdy, robust machine with the potential to produce metal parts 24 hours a day, opting eventually for a Haas VF-2 five-axis CNC machining centre with 30,000-rpm spindle. In 2011, the company also added a Haas OM-2 Office Mill, primarily to machine zirconium dioxide, an inorganic metal-based material commonly employed in modern dentistry. A second Haas OM-2 was added a few months later, in 2012.
Siebe’s father, Dr. Jef van der Zel, President and Chief Executive Officer, founded Cyrtina BV in 2004. The company quickly proved successful, and for several years was the biggest dental milling centre in Holland, operating around 50 small three-axis milling machines.
“Then, dental technicians, who would typically produce full restorations by hand from porcelain, started thinking they could invest in the machine tools and make the copings themselves,” says Siebe. “We knew we had to evolve and also produce crowns.” It was a case of eat or be eaten. “And so, we developed and patented a product called PRIMERO®: a layered crown created by CAD/CAM.” Primero, he claims, offers better aesthetics than conventional single-piece monolithic items, which makes it popular with patients. “Our crowns are very accurate and have a chameleon affect, because they are transparent, reflecting the light from adjacent teeth. The fit and the aesthetics are excellent!”
Of course, like many industries, Cyrtina faces stiff competition from China. For example, crowns in the Netherlands average around €250 each, whereas Chinese crowns cost €160 to €200. As a result, around 40% of crowns in the Dutch market originate from China. However, there are drawbacks.
“Our lead time is four days, but from China, it’s more like two or three weeks,” says Siebe. “Secondly, dentists like consistency; their core business is treating patients, so a good-fitting, impeccable crown is imperative. They don’t want to have to send back a crown if it’s faulty. It means more time and another appointment with the patient.”
Cyrtina now supplies 30% of its business directly to dentists, and this percentage is growing fast.
“We started out as just a milling centre, but now we are a cross between a milling centre and a dental lab creating crowns. Milling companies are becoming labs,” says Siebe. “The traditional labs are frustrated. They are going out of business. I say either they buy our products and become a retailer, or they lose their jobs.”
Cyrtina can produce 150 layered crowns with a single set of diamond-coated cutting tools (the biggest tool is 3 mm diameter) on the Haas OM-2. Although zirconium dioxide is soft, it is extremely abrasive. The crowns produced here are essentially a two-part system: the lower part is zirconium, while the outer layer is porcelain.
“We mill the coping and place it in a milled block where we create the stump,” explains Siebe. “Around this stump there is a milled cavity that is filled with a liquid porcelain material that we have created ourselves. The crown is then placed in a compression system and compacted, before being dried to create a crystalline structure, almost like sugar. We then use the OM-2 to mill it in ‘green’ shape, before it goes into the oven. Afterwards, it has the exact same characteristics as hardened steel. It’s practically impossible to break, and can withstand extremely high pressures. We call it ‘ceramic steel,’ and for this reason, our crowns come with a five-year warranty.”
Cyrtina calls its process “collaborative computerized dentistry” – almost every aspect of the business and manufacturing function is automated. Orders, for example, arrive digitally. The dentist either sends an intraoral scan or an impression that is scanned by Cyrtina’s ScanDesignCenter. The design work can then commence, using the company’s self-developed CAD system. Finally, models are created using a 3D printer, and once the design is finalized, automated production of the crown can commence.
“Orders pass automatically through our workflow, which includes a calculated mill path program created using Delcam’s PowerMILL CAM software for the Haas VF-2,” says Siebe. “Some of the parts we machine, such as indexed posts for example, require holes drilled at different angles, which is why we use 3+2-axis machining on all three Haas machines.”
Siebe first came across Haas on the Internet, before discovering that one of his competitors was also using Haas machines. As a result, his mind was made up.
“Haas is well known for producing machines that always work,” he says. “The price of the machine is also very important in that it is reflected in the end product price. From an accuracy perspective, we need to achieve 20 µm, which is no problem at all for Haas machines. Ultimately, the Haas machines make our products to specification, they never break down and we are making a bundle of money because of that. Furthermore, it’s an easy machine to operate – in two days you can be running a machine, even with little or no experience.”
Cyrtina is aiming to capture at least 10% of the Dutch market by the end of 2016. To achieve this goal, the company has just signed a contract with an investor group that will be involved in marketing its products. Cyrtina is also building up a new sales structure, with a new sales director and a CEO. Siebe’s father is 65 years old, and will step down as CEO, although he will remain involved with product development.
“It is very important that our business model is scalable,” says Siebe. “Towards the end of 2016, we intend to branch out beyond Benelux into Spain, France, Italy, and particularly Germany – Germans spend a great deal of money on dental work.”
Of course, these initiatives will require further investment, but here too, Cyrtina, which belongs to the European Fast 500 group of companies, has plans afoot.
“We are going to continue with Haas as our machine tool partner, slowly replacing our older three-axis machines with Haas OM-2 models, so we can enjoy consistent quality and operations,” he concludes. “The days of a traditional dental technician taking a coping and building it up by hand with porcelain are well and truly numbered. The future is automated machining of dental restorations. The costs will come down, and restorations will be accessible to many more people.”